Safe sex

Safe sex, also called safer sex, is a set of practices designed to reduce the risk of transmitting sexually-transmitted infections (STIs) (also known as sexually-transmitted diseases or STDs). Conversely, unsafe sex refers to engaging in sex without the use of any contraceptive or preventive measures against STDs.

Safer sex practices became prominent in the late 1980s as a result of the AIDS epidemic. From the viewpoint of society, safer sex can be regarded as a harm reduction strategy. Safe sex is about risk reduction, not complete risk elimination.

Although safe sex practices can be used as a form of family planning, the term refers to efforts made to prevent infection rather than conception. Many effective forms of contraception do not offer protection against STIs.

Terminology

Recently, and mostly within the United States, the use of the term safer sex rather than safe sex has gained greater use by health workers, with the realization the grounds that risk of transmission of sexually-transmitted infections in various sexual activities is a continuum rather than a simple dichotomy between risky and safe. However, in most other countries, including the United Kingdom and Australia, the term safe sex is still mainly used by sex educators. Because these terms are virtually synonymous with each other, they will be used interchangeably throughout this article.

Focus on AIDS

Much attention has focused on controlling HIV, the virus that causes AIDS, through the use of condoms, but each STI presents a different predicament. However, sex educators recommend that some form of barrier protection as a harm reduction measure should be used for all sexual activities which might potentially result in the exchange of body fluids.

Safe sex precautions

Abstinence

One way to avoid the risks associated with sexual contact is to abstain from sex entirely, which virtually elimates the chances of contracting STDs(Birth Control: Options and Methods). This approach is advocated by the members of many religions who oppose sex outside marriage, and is sometimes encouraged by the promotion of virginity pledges and sexual abstinence education for teenagers.

Masturbation

Solitary masturbation (including "phone sex" and "cybersex") is a safe form of sexual activity, so long as contact is not made with discharged bodily fluids (Reinisch Ph.D. 467).

Approaching sex with caution

Acknowleding that it is usually impossible to have entirely risk-free sex with another person, proponents of safer sex recommend that some of the following methods be used to minimize the risks of STI transmission and unwanted pregnancy.

• Monogamy or polyfidelity, practiced faithfully, is very safe (as far as STIs are concerned) when all partners are non-infected. However, many monogamous people have been infected with sexually-transmitted diseases by partners who are sexually unfaithful, have used injection drugs, or were infected by previous sexual partners; the same risks apply to polyfidelitous people, who face slightly higher risks depending on how many people are in the polyfidelitous group.
• Communication with one's sexual partner(s) makes for greater safety. Before initiating sexual activities, partners may discuss what activities they will and will not engage in, and what precautions they will take. This can reduce the chance of risky decisions being made "in the heat of passion".
• For those who are not monogamous, reducing the number of one's sexual partners, particularly anonymous sexual partners, may also reduce one's potential exposure to STIs. Similarly, one may restrict one's sexual contact to a community of trusted individuals - this is the approach taken by some pornographic actors and other non-monogamous people.
• Fluid bonding is a technique used by some polyamorous people to limit their exposure to STIs: partners agree to always use protection when having sex with anyone besides their fluid-bonded partner(s).
• Refraining from the use of recreational drugs, including alcohol, before and during sexual activity can protect against associated risks such as lowered inhibitions, impaired judgement, and loss of consciousness.

Preventing fluid exchange

Various devices are used to avoid contact with blood, vaginal fluid, and semen during sexual activity:

• Condoms cover the penis during sexual activity. They are most frequently made of latex, but can also be made out of polyurethane. Polyurethane is thought to be a safe material for use in condoms, since it is nonporous and viruses cannot pass through it. However, there is less research on its effectiveness than there is on latex.
• Female condoms are inserted into the vagina prior to intercourse. They may also be used for anal sex, although they are less effective.
• A dental dam (originally used in dentistry) is a sheet of latex used for protection when engaging in oral sex. It is typically used as a barrier between the mouth and the vagina during cunnilingus or between the mouth and the anus during anilingus. A piece of plastic wrap may be used as a dental dam; Plastic wrap has been tested by the FDA and CDC and found effective in preventing the transmission of virus-sized particles, although "microwave-safe" wrap may be ineffective . Latex condoms can also be cut to form an improvised dental dam.
• Medical gloves made out of latex, vinyl, nitrile, or polyurethane may be used as an ersatz dental dam during oral sex, or to protect the hands during mutual masturbation. Hands may have invisible cuts on them that may admit pathogens that are found in the semen or the vaginal fluids of STD infectees. Although the risk of infection in this manner is thought to be low , gloves can be used as an extra precaution.
• Another way to avoid contact with blood and semen is outercourse (non-penetrative sex), or forms of penetration that do not involve a penis, such as the use of dildos (when cleaned or covered with condoms).

Ineffective methods

Note that most methods of contraception other than the barrier methods mentioned above are not effective at preventing the spread of STIs.

The spermicide Nonoxynol-9 has been claimed to reduce the likelihood of STI transmission. However a recent study by the World Health Organization [1] has shown that Nonoxynol-9 is an irritant and can produce tiny tears in mucous membranes, which may increase the risk of transmission by offering pathogens more easy points of entry into the system. As a result condoms with a Nonoxynol-9 lubricant are not to be promoted.

Coitus interruptus (or "pulling out"), in which the penis is removed from the vagina, anus, or mouth before ejaculation, is not safe sex and can result in STI transmission or pregnancy. This is because of the formation of pre-ejaculate, a fluid (which may contain sperm) that oozes from the urethra before actual ejaculation. In addition, open sores on either partner can permit transmission. This does reduce the chance of STI transmission, however, and is sometimes recommended as a harm reduction strategy for those habitually engaging in unsafe intercourse.

Controversy

Some conservatives object to safe sex programs because they believe that providing education about condom use and other protective measures promotes non-procreative and promiscuous sex. As an alternative, they endorse abstinence before marriage and monogamy during marriage, arguing that this is the only reliable way to stop STIs. Many safe sex advocates believe that harm reduction is more practical than merely exhorting people to avoid having sex outside of marital relationships.

Some governments and organisations have been criticised heavily for promoting their beliefs in their HIV/AIDS programmes. UNFPA's request for $28 million dollars to offer birth control to Tsunami survivors is just one example. [2]

See also

• Condom
• Birth control
• Sexually transmitted disease

External links

• Sex: Safer and Satisfying from Planned Parenthood
• "Guide to Safer Sex" from the Society for Human Sexuality's sexuality.org site. Very explicit information on making various sexual practices safer:
  • Concise version (20k)
  • Long version (97k)
• Tiny Nibbles Safer Sex Chart - Presents risk levels of a variety of sexual activities and most major STIs.
• Template:Fr icon Condom use — with many pictures.